Chief Complaint. Ear Pain

CASE 1 EM is a 9 m.o. female who is here for follow up visit with Mother

Chief Complaint.   Ear Pain

Exam done ____

DX_____

 

Identify issue—– write like child has has this issues …explain due to doing this and that exam …. DX is _____

 

 

DDX__1

 

DDX 2

 

 

Explain patho of each diagnosis.

 

AND summarize the treatment options .this must supported by clinical guidelines and 3 different refrence

 

Case Study: EM, 9-Month-Old Female with Ear Pain

Introduction
EM is a 9-month-old female who presents for a follow-up visit with her mother. The chief complaint is ear pain. According to her mother, EM has been tugging at her right ear, appears more irritable than usual, has had difficulty sleeping, and experienced a low-grade fever of 100.9°F for the past two days. She recently had symptoms of a mild upper respiratory infection, including nasal congestion and a cough.

Examination and Diagnosis
Upon physical examination, EM is alert but fussy. Otoscopic examination reveals a bulging, erythematous right tympanic membrane with decreased mobility on pneumatic otoscopy. There is no discharge noted, and the left ear appears normal. Vital signs are stable, though the patient remains febrile at 100.9°F. Lungs are clear, and the rest of the physical exam is unremarkable.

Based on the history and examination, the most likely diagnosis is Acute Otitis Media (AOM).

Identified Issue
EM has been diagnosed with acute otitis media, most likely due to eustachian tube dysfunction following a recent upper respiratory infection. Infants and young children are more prone to AOM because their eustachian tubes are shorter, more horizontal, and function less effectively than in older children and adults. The infection leads to inflammation, resulting in fluid accumulation and bacterial growth behind the tympanic membrane.

Differential Diagnoses (DDx)

1. Otitis Media with Effusion (OME)

2. Teething-associated ear discomfort

Pathophysiology of Diagnoses

1. Acute Otitis Media (AOM)
   AOM is a rapid-onset infection of the middle ear, commonly caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis. Viral infections often precede AOM and contribute to inflammation and obstruction of the eustachian tube. The resultant negative pressure allows fluid to accumulate in the middle ear, creating an environment for bacterial growth. The inflammation and increased pressure lead to ear pain and fever. (Lieberthal et al., 2013)

2. Otitis Media with Effusion (OME)
   OME involves the presence of non-purulent fluid in the middle ear without signs or symptoms of acute infection. It typically follows an episode of AOM or arises from eustachian tube dysfunction. The condition is often asymptomatic but can be associated with hearing loss or a sensation of fullness in the ear. Otoscopy usually reveals a retracted or neutral tympanic membrane with visible fluid levels but no bulging or erythema. (Rosenfeld et al., 2016)

3. Teething-associated ear discomfort
   Teething can cause referred pain that mimics ear pain, especially in infants. There may be increased drooling and gum irritation, but no fever or tympanic membrane abnormalities on exam. This diagnosis is made clinically and requires exclusion of AOM and OME.

Treatment Options
According to the American Academy of Pediatrics (AAP) guidelines, first-line treatment for AOM in children under 2 years old with moderate to severe symptoms includes high-dose amoxicillin (80–90 mg/kg/day divided twice daily) for 7–10 days. If the child has recently taken amoxicillin or has conjunctivitis, amoxicillin-clavulanate may be used. Pain management with acetaminophen or ibuprofen is essential for symptom relief. Observation may be appropriate for children over 6 months with mild symptoms and no risk factors, but EM’s age and symptomatic presentation warrant antibiotic treatment. (Lieberthal et al., 2013)

For OME, the treatment is usually watchful waiting for 3 months unless there is evidence of hearing loss or developmental delay. Antibiotics and antihistamines are not recommended for initial management. (Rosenfeld et al., 2016)

Teething-related discomfort is managed conservatively with oral analgesics, gum massage, or teething rings.

Conclusion
EM’s clinical presentation of ear pain, irritability, fever, and bulging tympanic membrane confirms the diagnosis of acute otitis media. This condition is common in infants following viral respiratory infections. The treatment includes high-dose amoxicillin as per clinical guidelines, with a focus on pain relief and close follow-up. Differential diagnoses such as OME and teething must be ruled out through thorough examination. Timely diagnosis and guideline-based treatment help prevent complications and promote recovery in pediatric patients.

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References

Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M. A., … & Schwartz, R. H. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964-e999. https://doi.org/10.1542/peds.2012-3488

Rosenfeld, R. M., Shin, J. J., Schwartz, S. R., Coggins, R., Gagnon, L., Hackell, J. M., … & Tunkel, D. E. (2016). Clinical practice guideline: Otitis media with effusion (update). Otolaryngology–Head and Neck Surgery, 154(1_suppl), S1-S41. https://doi.org/10.1177/0194599815623467

Centers for Disease Control and Prevention (CDC). (2022). Ear infection (otitis media). https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/ear-infection.html